Mr. Speaker: May I thank all hon. Members for their kind messages and the Officers of the House, members of staff and members of the public who were so kind to me during my absence? It is very appropriate that I should come back to call questions to the Secretary of State for Health.
1. Dr. Evan Harris (Oxford, West and Abingdon)
(LD): What estimate she has made of the number of vacancies for (a) doctors, (b) nurses and (c) professions
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allied to medicine in the NHS, including posts filled by agency or locum staff. 
The Secretary of State for Health (Ms Patricia Hewitt): On behalf of the whole House, may I say how delighted we are to welcome you back, Mr. Speaker? I am sure that you were in the very safe hands of the NHS, even if it was in Scotland rather than in England.
The number of vacancies for doctors, nurses and qualified allied health professionals is the lowest for three years. In March 2005, the number of vacancies for doctors was about 1,200, for nurses about 5,800 and for qualified allied health professionals about 1,700.
At a time when the NHS is having trouble filling the thousands of vacancies that the Secretary of State described, is it sensible that up and down the country it should be making redundant front-line doctors, nurses and ancillary staff, including the threat hanging over hundreds of jobs in Oxfordshire? Will the Secretary of State recognise that the health service should not have to choose between front-line patient care and balancing the books this year? Will she give it more time?
Ms Hewitt: I am surprised that the hon. Gentleman did not mention the fact that there are now 2,700 more nurses in the Thames valley alone than there were in 1997 and significantly more GPs, consultants and, I am delighted to say, dentists. Against that background, a small number of hospitals, including the Radcliffewhich, incidentally, has one of its lowest-ever vacancy ratesare having to consider making a small number of staff redundant.
I hope that the hon. Gentleman agrees that we want every hospital to use the most efficient and effective ways of looking after patients. Where that means, for instance, more day case surgery or lower average lengths of stay, with better patient care but fewer hospital beds
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and therefore fewer hospital staff but more staff in the community, I hope that he, like me, will support hospitals in making those decisions, because they are good for patients as well as good value for money.
Mr. Kevin Barron (Rother Valley) (Lab): Does my right hon. Friend agree that even if today's media reports were true and we were to lose 500 health workers jobs a week for the next six months, hundreds of thousands more people would still be working in the NHS than nine years ago?
Ms Hewitt: My right hon. Friend is absolutely right. We have more than 200,000 more staff in the NHS, including 78,000 more nurses, than we had in 1997. Reports of thousands of job losses are nonsensical. As hospitals become more effective and use more modern medical technology, more services are being provided in the communityfor instance, looking after patients with chronic heart disease in their own homesslashing the number of emergency admissions, which I hope all Members support. Where that means fewer staff in acute wards in some hospitals but more staff in the community, that is the right thing to do when it delivers better patient care with better value for money.
Mr. Shailesh Vara (North-West Cambridgeshire) (Con): Given that many primary care trusts are not replacing jobs to ensure that employment numbers are kept low, will the Secretary of State undertake to publish regular employment figures for trusts so that we know exactly where job losses are occurring?
Ms Hewitt: We publish annual work force survey figures and we shall shortly publish the latest figures so that we can track exactly those changes. The hon. Gentleman and his colleagues need to decide whether they support a more efficient NHS and whether they support more services being delivered in the communityin community hospitals, health centres and patients' own homesbecause that is clearly what the public want and what we will deliver.
Jonathan Shaw (Chatham and Aylesford) (Lab): Does my right hon. Friend agree that our NHS would not function if it were not for the outstanding contribution of people from abroad? Does she share my concern about reports that trainee doctors who have come to the UK in good faith are having their training interrupted by new visa regulations? What is she doing about that, particularly in terms of discussions with the Home Office?
My hon. Friend makes a very important point. Indeed, for many decades, the NHS has been indebted to staff from abroad. The Home Office has recently announced a change to the arrangements for the immigration status of doctors who come from abroad to complete their training, but we have put in place transitional arrangements to protect doctors who, for instance, may have come here with three years' leave but are taking part in a specialist registrar training programme that may well last five years. The transitional arrangements will ensure that they can complete that training programme. However, my officials are meeting the Indian high commission, which
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has expressed concern, and the British Medical Association this afternoon to find out whether anything further needs to be done to clarify the arrangements, particularly the transitional arrangements, but the fundamental reason why we can make those changes is that we have been successful in training far more of our own doctors and nurses in this country.
Sir Patrick Cormack (South Staffordshire) (Con): In endorsing the Secretary of State's warm welcome to you, Sir, may I ask her whether she is aware that, when I was first elected to the House, almost every one of my constituents was served by a GP who provided an after-hours service. Not one of them is now provided with such a service. Is that progress?
Ms Hewitt: That choice was made by GPs and many others. When we negotiated the new contract for GPs, one of their main concerns was that they should be able to choose whether they provided out-of-hours services themselves or whether they left it to the local primary care trust to make other arrangements. As a result of the new contract, we have ensured that GPs are doing more preventive work than ever before. Indeed, thousands of people are alive and well today as a direct result of that contract, and we are now ensuring from this month onwards that more of GPs' pay is directly linked to patients' satisfaction with GP services, including access to appointments.
Mr. Andrew Lansley (South Cambridgeshire) (Con): May I, on behalf of Conservative Members, express our warm appreciation of your being back in the Chair again, Mr. Speaker? Welcome back. You are indeed a testament to the quality of care in the NHS, and we are delighted to see you.
This morning, the Prime Minister has been talking about the fulfilment of the Government's NHS plan, one of the central aspects of which was to recruit more doctors and nurses. Will the Secretary of State therefore explain to NHS staff how it can make sense for 8,000 posts to have been lost in NHS hospitals over the past eight weeks, with thousands more job losses to come, not according to us, but according to what is termed a senior source in the Department of Health this morning?
Ms Hewitt: The figures that the hon. Gentleman is so fond of quoting are simply rubbish. What we are seeing in many hospitals, as they seek to become even more efficient and effective, is a very significant reduction in the use of agency staff, which, as any nurse will say, is an extremely expensive and inefficient way to organise their ward rotas. As hospitals do more day-case surgery and as they work with PCTs to reduce emergency admission rates, they need fewer acute beds and therefore, in some cases, fewer staff in hospitals, but they are achieving that by reducing their agency staffing and by not filling vacancies in some cases. Very few hospitals indeed will need to consider redundancies, although some may now be consulting on them. That is enormously worrying for the staff involved, and everything will be done to keep the redundancies to a minimum, but the hon. Gentleman needs to tell us whether he is committed to
Mr. Lansley: We are committed to a successful NHS, which can be achieved only if we have doctors and nurses providing services to patients. Whether they are in hospital or in primary care, those who are recruited to the NHSdoctors, nurses and physiotherapistsclearly have a reasonable expectation that, after their education and training, they should find posts. Can the Secretary of State therefore explain why expensively educated and trained junior doctors cannot find posts; why, in the west midlands, 2,000 out of 4,000 nurses leaving training cannot find posts; and why more than half of the physiotherapists who left training last year could not find posts anywhere in the NHS?
Ms Hewitt: More staff are employed in the NHS than ever beforethousands more than under the Conservative Government. Vacancy rates for doctors and nurses are downin the case of nurses, to their lowest level since records began. Of course that means that, for some new graduates, it is harder to find jobs than it used to be. That is because there are so many more nurses and doctors in employment and considerably fewer vacancies.
We come back to the issue of whether we are going to support hospitals in becoming more effective and efficient and using fewer agency staff. West Hertfordshire, for instance, had a deficit last year of £18 million and an agency staffing bill of £17 million. The Government think that it makes sense to support that hospital in reorganising its permanent
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